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<br /> ELECT-MAL MMAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)4.252'57-8810 J FAX 425-257-8857 J (E)everetteps@everettwa.gov J www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 1 O_[2-9 � '1 i U {Z Y1�l�f tom
<br /> BUILDING AREA(if residential,new construction,remodel,or ad� /
<br /> on) SF
<br /> BUILDING TYPE: El SFR-DETACHED D SFR ATTACHED El DUPLEX D MULTIFAMILY-#OF UNITS: 1I COMMERCIAL
<br /> USE oFBUILDING: EV TT
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<br /> CONTRACT PRICE OF WORK:$ .
<br /> NUMBER OF DEVICES(if low voltage):•
<br /> FIRE ALARM? D YES 14 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: V1S)-CL( f rtc-e,�T-acie..S + I tGI 1I 5 01'1
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<br /> OWNER NAME: TENANT NAME(if Commercial): B /(J6
<br /> OWNER MAILING ADDRESS: sir poi > DX 3707
<br /> cm( ..5ai 7TLa' STATE 017G1q/2q 22x7
<br /> OWNER PHONE: OWNER.EMAIL:
<br /> +J4+
<br /> CONTRACTOR NAME: 4e),,)67e Lox
<br /> CONTRACTOR ADDRESS: sii r Pa LOX 44
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<br /> CONTRACTOR PHONE:426j'426-2/44144 q 44 p CONTRACTOR EMAIL: ki�"1e f. iMAIM Ef e 2 ki, -w f/r", eOi7
<br /> CONTRACTOR LIC.#(REQUfRED): £E V /�C4j p� OZ, C1TY OF EVERETT EIUSIIVESS LIC,te(REQUIRED):005
<br /> PRIMARY CONTACT: EI OWNER Igl CONTRACTOR El OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2 6-65449
<br /> 15 640W CONTACT EMAIL: DE/ iq IS.e,eJL()o til 'id!T. &O/11
<br /> AORFEMEN7 T hereby°et*that 1 have read end examined this application and know the same to be true and correct. All provisions oflaw.s and ordinances governing this
<br /> type of work will be completed whether specified hereinornot The granting of a permit does not presume to giVe authorffyto violate or cancel the provisfons of any other state or'
<br /> local law regulating construction or the performance of construotlon That l am authorized by the owner ofthls property to perform the work for which application Is made and I
<br /> comply with the State Contractors Law 18.27ROW and 298.20d WAG.
<br /> City of.Evereft Official Use 0
<br /> FEE 1
<br /> + ,,
<br /> •
<br /> PERMIT#E R( c -oc
<br /> OwnerlAu or ad AgenLSignature Date (Revised 10/12/2096]
<br />
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